pharmacy 6 june, 2012. introduction why pharmacy whats the problem what should we do about it for...
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Pharmacy
6 June, 2012
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Introduction
• Why Pharmacy
• What’s the problem
• What should we do about it
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Why Pharmacy
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Population Illness Episode Intermediate Products
Resources Operating Costs
Why Pharmacy
Lee and Jones Model
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Population Illness Episode Intermediate Products
Resources Operating Costs
Reduce the rate at which
the population becomes ill
Select “best” treatment model and
location
Implement best practice
treatment protocols
Engineer the delivery of
intermediate products
Alloc’t “Make” resources,
Supplemental, Contract buy
Why Pharmacy
Lee and Jones Model
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What’s the problem
• Critical Resource: Pharmacist
• Manual• Variance• Low volume/Geo isolation
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Prescribe Fill Compliance
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What should we do about it
• Leverage technology• Automation (robots)• Tele-Pharmacy
• Maximize Pharmacist Value-added activity
• Provider prescribing• Patient compliance
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Appendix
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Patient compliance
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Patients have been shown to abandon their treatment. Pharmacists actively communicate with patients regarding refills and prescription issues to increase patient adherence
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Patient compliance
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Reduction in total patient costs can be achieved with proactive pharmacists monitoring
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Current Pharmacy Operations Cost
Retail Prescriptions* Retail Cost*
Current State Statistics•Navy follows same general trend as DoD
•Retail Rx volumes increasing w/ Direct Care decreasing
•Retail drug costs Increasing
• Avg. ~$40 extra cost/Rx in Retail vs. Direct
Additional Costs
• Capital Investment: Automation replacement
• Inventory: $82 M with 60-day stock
• Rx replacement, Loss to Retail
• Patient Abandonment
*M2/PDTS Data: DoD Pharmacy Operations Center (Note: Mail Order Total Cost misleading due to dispensing fee being dropped and some ingredient cost issues after TPharm activated on 4 Nov 2009)
+27%
-2%
+33%
-5%
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Bank Teller Pharmacy Queuing Models•Bank Teller: Patient waits until called to window and then served (left)
•In-and-out: Patient submits Rx, sits down, and waits to be called again for Rx dispense and consult (below)
Pharmacy Standardization
•NO patient queuing standardization
•NO prescription fill process standardization
•Limited centrally driven decision making
In-and-out
Patient Arrives
Prescription Filled
Prescription Dispensed
Patient Arrives
Prescription Dispensed
Prescription Filled
Patient Queuing and Prescription Processing
Models
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Wait Time and Abandonment
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Pharmacy Automation Guiding Principles
• Single Piece Flow
• High Level of Automation
• Minimal Interruptions/Distractions
• Division of Labor
• Standardization
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New System ObjectivesQuality
Errors: Fill errors are reduced by 2/3
Value-added Pharmacist time:10% more time is dedicated to high
valued-added tasksAccess
Overall processing time:30 minute processing time From 1000 to 1400 for the 90th
percentile patientTicket abandonment:
Ticket abandonment is reduced by 1/3Cost
Staffing:10% reduction in tech staffing 10% increase in Pharmacist value-
added time
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• In/ Out process patient queuing
• Automated labeling and capping
• Single piece flow tote system
• Conveyor transport
• Re-engineered workstations
• Medication storage optimization
Automation System Elements Layout
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• Top 250-275 high demand items within arms reach of technician
• Computer, pill counter, barcode scanner, and labeler
• Dimensions: 10 ft length, 7 ft height, 2 ft depth
Automation system elements
Fast mover workstation
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• Fast movers in front / Slow movers behind
• ~ 760 additional items per work station
•~ 1,520 items total in two stations
•This is bulk storage for all items with < 4 fills per week
Automation system elements
Fast and slow mover workstation
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• Two automation robots for oral tablets
• 150 - 200 cells in each robot
• Highest mover items in both machines
• Automation controls tote movement along conveyor systems
• Perpetual inventory
Automation system elements
Robot automation
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• Designed to minimize disruptions
• Reinforces single piece flow
• C2s and refrigerated items in close proximity
• Dispensing windows in close proximity
Automation system elementsPharmacist verification
workstations
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Dashboards
ExamplesToday
Past 14 days
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Conveyor Concept In Use Around the Navy
• Scott Center• Naval Hospital San Diego
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Patient Experience Fast Mover Work Stations
Patient Experience
• Maximum wait decreased from 2 hrs to 45 min
• Improved flexibility (not “holding” patients in the waiting room)
• Error rates decreased by a factor of 50 (0.5% to 0.01% error rate)
Pharmacist Verification
Conveyor Concept in Military Environment
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